High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis
Authors: Tom Arild Torstensen, Håvard Østerås, Riccardo LoMartire, Georg Mørtvedt Rugelbak, Wilhelmus Johannes Andreas Grooten, Björn Olov Äng
Journal: Annals of Internal Medicine (2023)

LettersJuly 2023High- Versus Low-Dose Exercise Therapy for Knee OsteoarthritisTom Arild Torstensen, MSc, RPT, Håvard Østerås, MSc, RPT, Riccardo LoMartire, PhD, RPT, Georg Mørtvedt Rugelbak, MSc, RPT, Wilhelmus Johannes Andreas Grooten, PhD, RPT, Björn Olov Äng, PhD, RPTTom Arild Torstensen, MSc, RPTDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, SwedenSearch for more papers by this author, Håvard Østerås, MSc, RPTDepartment of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, and Rosenborg Fysioterapiklinikk, Trondheim, NorwaySearch for more papers by this author, Riccardo LoMartire, PhD, RPTDepartment of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, SwedenSearch for more papers by this author, Georg Mørtvedt Rugelbak, MSc, RPTRosenborg Fysioterapiklinikk, Trondheim, NorwaySearch for more papers by this author, Wilhelmus Johannes Andreas Grooten, PhD, RPTDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, SwedenSearch for more papers by this author, Björn Olov Äng, PhD, RPTDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden, and Department of Health and Welfare, Dalarna University, Falun, SwedenSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0141 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We appreciate Dr. Knoop and colleagues' insightful comments suggesting a fourth explanation for our results related to muscle strength. They contend that low-dose exercise should be preferred over high-dose exercise by referring to a threshold value in muscle strength and performance of daily activities; above this threshold, the specific dose or intensity of exercise therapy is no longer of clinical relevance. However, ours is a superiority trial; therefore, we can conclude only that high-dose therapy is not superior to low-dose therapy, not that low-dose therapy is as effective. Moreover—although their hypothesis is interesting—our randomized controlled trial did not ...References1. Graven-Nielsen T,Arendt-Nielsen L. Impact of clinical and experimental pain on muscle strength and activity. Curr Rheumatol Rep. 2008;10:475-81. [PMID: 19007539] CrossrefMedlineGoogle Scholar2. Fuentes J, Armijo-Olivo S, Funabashi M, et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014;94:477-89. [PMID: 24309616] doi:10.2522/ptj.20130118 CrossrefMedlineGoogle Scholar3. Zou K, Wong J, Abdullah N, et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis. 2016;75:1964-1970. [PMID: 26882927] doi:10.1136/annrheumdis-2015-208387 CrossrefMedlineGoogle Scholar4. Miller CT, Owen PJ, Than CA, et al. Attempting to separate placebo effects from exercise in chronic pain: a systematic review and meta-analysis. Sports Med. 2022;52:789-816. [PMID: 34453277] doi:10.1007/s40279-021-01526-6 CrossrefMedlineGoogle Scholar5. Pace-Schott EF, Amole MC, Aue T, et al. Physiological feelings. Neurosci Biobehav Rev. 2019;103:267-304. [PMID: 31125635] doi:10.1016/j.neubiorev.2019.05.002 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Tom Arild Torstensen, MSc, RPT; Håvard Østerås, MSc, RPT; Riccardo LoMartire, PhD, RPT; Georg Mørtvedt Rugelbak, MSc, RPT; Wilhelmus Johannes Andreas Grooten, PhD, RPT; Björn Olov Äng, PhD, RPTAffiliations: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, SwedenDepartment of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, and Rosenborg Fysioterapiklinikk, Trondheim, NorwayDepartment of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, SwedenRosenborg Fysioterapiklinikk, Trondheim, NorwayDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, SwedenDepartment of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden, and Department of Health and Welfare, Dalarna University, Falun, SwedenDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2348. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis Tom Arild Torstensen , Håvard Østerås , Riccardo LoMartire , Georg Mørtvedt Rugelbak , Wilhelmus Johannes Andreas Grooten , and Björn Olov Äng High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis Jesper Knoop , Joost Dekker , Marike van der Leeden , Martin van der Esch , Raymond W.J.G. Ostelo Metrics July 2023Volume 176, Issue 7KeywordsExercise therapyKneesOsteoarthritisRandomized trials ePublished: 18 July 2023 Issue Published: July 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...